Dosing & Uses
Dosage Forms & Strengths
ticarcillin/clavulanate
injection, powder for reconstitution
- (3g/100mg)/vial
- (30g/1g)/bulk vial
ready-to-use IV solution
- (3g/100mg)/100mL
Septicemia
Indicated for septicemia caused by beta-lactamase–producing isolates of Klebsiella spp, Escherichia coli, Staphylococcus aureus, or Pseudomonas aeruginosa
3.1 g IV q4-6hr
Lower Respiratory Infections
Indicated for lower respiratory infections caused by beta-lactamase–producing isolates of S. aureus, Haemophilus influenzae, or Klebsiella spp
3.1 g IV q4-6hr
Bone & Joint Infections
Indicated for bone and joint infections caused by beta-lactamase–producing isolates of S. aureus
3.1 g IV q4-6hr
Skin & Skin Structure Infections
Indicated for skin and skin structure infections caused by beta-lactamase–producing isolates of S. aureus, Klebsiella spp, or E. coli
3.1 g IV q4-6hr
Urinary Tract Infections
Indicated for UTIs (complicated or uncomplicated) caused by beta-lactamase–producing isolates of E. coli, Klebsiella spp, P. aeruginosa (or other Pseudomonas spp), Citrobacter spp, Enterobacter cloacae, Serratia marcescens, or S. aureus
3.1 g IV q4-6hr
Intra-abdominal Infections
Indicated for peritonitis caused by beta-lactamase–producing isolates of E. coli, K. pneumoniae, or Bacteroides fragilis group
3.1 g IV q4-6hr
Gynecologic Infections
Indicated for endometritis caused by beta-lactamase–producing isolates of Prevotella melaninogenicus, Enterobacter spp (including E. cloacae), E. coli, Klebsiella pneumoniae, S. aureus, or Staphylococcus epidermidis
Dose based on ticarcillin component
Moderate: 200 mg/kg/day IV divided q4-6hr
Severe: 300 mg/kg/day IV divided q4hr
Renal Impairment
Load: 3.1 g IV, THEN reduce maintenance dose based on creatinine clearance
CrCl 30-60 mL/min: 2 g q4hr
CrCl 10-30 mL/min: 2 g q8hr
CrCl <10 mL/min: 2 g q12hr
CrCl<10 mL/min & hepatic impairment: 2 g qDay
Peritoneal dialysis: 3 g q12hr
Hemodialysis: 2 g q12hr; supplement with 3 g after each dialysis session
Dosing Considerations
Treatment duration depends upon infection severity, but is typically 10-14 days; however, in difficult and complicated infections, more prolonged therapy may be required
Dosage Forms & Strengths
ticarcillin/clavulanate
injection, powder for reconstitution
- (3g/100mg)/vial
- (30g/1g)/bulk vial
ready-to-use IV solution
- (3g/100mg)/100mL
Infections
Dose based on ticarcillin component
<3 months: Safety and efficacy not established
<60 kg and >3 months: 200-300 mg/kg/day IV divided q4-6hr; not to exceed 24 g/day
≥60 kg: As adults; 3.1 g IV q4-6hr
Neonates
- (<7 days old, <2 kg) OR (>7 days old, <1.2 kg): 150 mg/kg/day IV divided q12hr
- (<7 days old, >2 kg) OR (>7 days old, 1.2-2 kg): 225 mg/kg/day IV divided q8hr
- >7 days old, >2 kg: 300 mg/kg/day IV divided q8hr
Cystic Fibrosis
300-600 mg/kg/day IV/IM divided q6hr; not to exceed 24 g/day
Indications
Septicemia caused by beta-lactamase–producing isolates of Klebsiella spp, Escherichia coli, Staphylococcus aureus, or Pseudomonas aeruginosa
Lower respiratory infections caused by beta-lactamase–producing isolates of S. aureus, or Klebsiella spp; note that use is not established for Haemophilus influenzae type B
Bone and joint infections caused by beta-lactamase–producing isolates of S. aureus
Skin and skin structure infections caused by beta-lactamase–producing isolates of S. aureus, Klebsiella spp, or E. coli
UTIs (complicated or uncomplicated) caused by beta-lactamase–producing isolates of E. coli, Klebsiella spp, P. aeruginosa (or other Pseudomonas spp), Citrobacter spp, Enterobacter cloacae, Serratia marcescens, or S. aureus
Peritonitis caused by beta-lactamase–producing isolates of E. coli, K. pneumoniae, or Bacteroides fragilis group
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (12)
- BCG vaccine live
ticarcillin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- cholera vaccine
ticarcillin, cholera vaccine. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid coadministration of cholera vaccine with systemic antibiotics since these agents may be active against the vaccine strain. Do not administer cholera vaccine to patients who have received oral or parenteral antibiotics within 14 days prior to vaccination.
- demeclocycline
demeclocycline decreases effects of ticarcillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug.
- doxycycline
doxycycline decreases effects of ticarcillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug.
- microbiota oral
ticarcillin decreases effects of microbiota oral by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Microbiota oral contains bacterial spores. Antibacterial agents may decrease efficacy if coadministered. Complete antibiotic regimens 2-4 days before initiating microbiota oral. .
- minocycline
minocycline decreases effects of ticarcillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug.
- mycophenolate
ticarcillin, mycophenolate. Either increases levels of the other by decreasing renal clearance. Avoid or Use Alternate Drug.
- omadacycline
omadacycline decreases effects of ticarcillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Tetracyclines may interfere with the bactericidal action of penicillins. Monitor for decreased therapeutic effects of penicillins if concomitantly used with a tetracycline.
- oxytetracycline
oxytetracycline decreases effects of ticarcillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug.
- pexidartinib
clavulanate and pexidartinib both increase Other (see comment). Avoid or Use Alternate Drug. Pexidartinib can cause hepatotoxicity. Avoid coadministration of pexidartinib with other products know to cause hepatoxicity.
- pretomanid
clavulanate, pretomanid. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Pretomanid regimen associated with hepatotoxicity. Avoid alcohol and hepatotoxic agents, including herbal supplements and drugs other than bedaquiline and linezolid.
- probenecid
ticarcillin, probenecid. Either increases levels of the other by decreasing renal clearance. Avoid or Use Alternate Drug.
Monitor Closely (77)
- aceclofenac
ticarcillin, aceclofenac. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
ticarcillin, aceclofenac. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - acemetacin
ticarcillin, acemetacin. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
ticarcillin, acemetacin. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - acyclovir
ticarcillin, acyclovir. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
- amiloride
ticarcillin increases effects of amiloride by unspecified interaction mechanism. Use Caution/Monitor. Hyperkalemia.
- aspirin
ticarcillin, aspirin. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
ticarcillin, aspirin. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - aspirin rectal
ticarcillin, aspirin rectal. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
ticarcillin, aspirin rectal. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor. - aspirin/citric acid/sodium bicarbonate
ticarcillin, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
ticarcillin, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor. - balsalazide
ticarcillin, balsalazide. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
- bazedoxifene/conjugated estrogens
ticarcillin will decrease the level or effect of bazedoxifene/conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- bendroflumethiazide
ticarcillin, bendroflumethiazide. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
- bupropion
ticarcillin increases toxicity of bupropion by unspecified interaction mechanism. Use Caution/Monitor. May lower seizure threshold; keep bupropion dose as low as possible.
- cefadroxil
ticarcillin, cefadroxil. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
- cefamandole
ticarcillin, cefamandole. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
- cefotaxime
ticarcillin, cefotaxime. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
- cefpirome
ticarcillin, cefpirome. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
- cefprozil
ticarcillin, cefprozil. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
- ceftibuten
ticarcillin, ceftibuten. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
- celecoxib
ticarcillin, celecoxib. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
ticarcillin, celecoxib. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - cephalexin
ticarcillin, cephalexin. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
- chlorothiazide
ticarcillin, chlorothiazide. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
- chlorpropamide
ticarcillin, chlorpropamide. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
- chlorthalidone
ticarcillin, chlorthalidone. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
- choline magnesium trisalicylate
ticarcillin, choline magnesium trisalicylate. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
ticarcillin, choline magnesium trisalicylate. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor. - conjugated estrogens
ticarcillin will decrease the level or effect of conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- cyclopenthiazide
ticarcillin, cyclopenthiazide. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
- diclofenac
ticarcillin, diclofenac. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
ticarcillin, diclofenac. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - dienogest/estradiol valerate
ticarcillin will decrease the level or effect of dienogest/estradiol valerate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. An alternate or additional form of birth control may be advisable during concomitant use.
- diflunisal
ticarcillin, diflunisal. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
ticarcillin, diflunisal. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - digoxin
ticarcillin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.
- drospirenone
ticarcillin increases effects of drospirenone by unspecified interaction mechanism. Use Caution/Monitor. Hyperkalemia.
- estradiol
ticarcillin will decrease the level or effect of estradiol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- estrogens conjugated synthetic
ticarcillin will decrease the level or effect of estrogens conjugated synthetic by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- estropipate
ticarcillin will decrease the level or effect of estropipate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- ethinylestradiol
ticarcillin will decrease the level or effect of ethinylestradiol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- etodolac
ticarcillin, etodolac. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
ticarcillin, etodolac. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - fenbufen
ticarcillin, fenbufen. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
ticarcillin, fenbufen. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - fenoprofen
ticarcillin, fenoprofen. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
ticarcillin, fenoprofen. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - flurbiprofen
ticarcillin, flurbiprofen. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
ticarcillin, flurbiprofen. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - ganciclovir
ticarcillin, ganciclovir. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
- hydrochlorothiazide
ticarcillin, hydrochlorothiazide. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
- ibuprofen
ticarcillin, ibuprofen. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
ticarcillin, ibuprofen. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - ibuprofen IV
ticarcillin, ibuprofen IV. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
ticarcillin, ibuprofen IV. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor. - indapamide
ticarcillin, indapamide. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
- indomethacin
ticarcillin, indomethacin. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
ticarcillin, indomethacin. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - ketoprofen
ticarcillin, ketoprofen. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
ticarcillin, ketoprofen. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - ketorolac
ticarcillin, ketorolac. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
ticarcillin, ketorolac. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - ketorolac intranasal
ticarcillin, ketorolac intranasal. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
ticarcillin, ketorolac intranasal. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor. - levonorgestrel oral/ethinylestradiol/ferrous bisglycinate
ticarcillin will decrease the level or effect of levonorgestrel oral/ethinylestradiol/ferrous bisglycinate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. Antibiotics may decrease hormonal contraceptive efficacy.
- lornoxicam
ticarcillin, lornoxicam. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
ticarcillin, lornoxicam. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - meclofenamate
ticarcillin, meclofenamate. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
ticarcillin, meclofenamate. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor. - mefenamic acid
ticarcillin, mefenamic acid. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
ticarcillin, mefenamic acid. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - meloxicam
ticarcillin, meloxicam. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
ticarcillin, meloxicam. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - mesalamine
ticarcillin, mesalamine. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
- mestranol
ticarcillin will decrease the level or effect of mestranol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- methotrexate
ticarcillin increases levels of methotrexate by decreasing renal clearance. Use Caution/Monitor. Increased serum concentrations of methotrexate with concomitant hematologic and gastrointestinal toxicity have been observed with concurrent administration of high or low doses of methotrexate and penicillins.
- methyclothiazide
ticarcillin, methyclothiazide. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
- metolazone
ticarcillin, metolazone. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
- mipomersen
mipomersen, clavulanate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Both drugs have potential to increase hepatic enzymes; monitor LFTs.
- nabumetone
ticarcillin, nabumetone. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
ticarcillin, nabumetone. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - naproxen
ticarcillin, naproxen. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
ticarcillin, naproxen. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - oxaprozin
ticarcillin, oxaprozin. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
ticarcillin, oxaprozin. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - parecoxib
ticarcillin, parecoxib. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
ticarcillin, parecoxib. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - piroxicam
ticarcillin, piroxicam. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
ticarcillin, piroxicam. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - rose hips
ticarcillin, rose hips. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
- salicylates (non-asa)
ticarcillin, salicylates (non-asa). Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
ticarcillin, salicylates (non-asa). Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - salsalate
ticarcillin, salsalate. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
ticarcillin, salsalate. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - sodium phenylacetate
ticarcillin, sodium phenylacetate. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
- sodium picosulfate/magnesium oxide/anhydrous citric acid
ticarcillin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- spironolactone
ticarcillin increases effects of spironolactone by unspecified interaction mechanism. Use Caution/Monitor. Hyperkalemia.
- sulfasalazine
ticarcillin, sulfasalazine. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
ticarcillin, sulfasalazine. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - sulindac
ticarcillin, sulindac. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
ticarcillin, sulindac. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - tolfenamic acid
ticarcillin, tolfenamic acid. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
ticarcillin, tolfenamic acid. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - tolmetin
ticarcillin, tolmetin. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
ticarcillin, tolmetin. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - triamterene
ticarcillin increases effects of triamterene by unspecified interaction mechanism. Use Caution/Monitor. Hyperkalemia.
- valganciclovir
ticarcillin, valganciclovir. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
- valoctocogene roxaparvovec
clavulanate and valoctocogene roxaparvovec both increase Other (see comment). Use Caution/Monitor. Medications that may cause hepatotoxicity when combined with valoctogene roxaparvovec may potentiate the risk of elevated liver enzymes. Closely monitor these medications and consider alternative medications in case of potential drug interactions.
- warfarin
ticarcillin, warfarin. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Platelet dysfunction occurs with extended-spectrum penicillins in varying degrees. Monitor INR and adjust warfarin dose if needed.
Minor (22)
- amikacin
ticarcillin decreases effects of amikacin by altering metabolism. Minor/Significance Unknown. Increased risk in renal impairment.
- azithromycin
azithromycin decreases effects of ticarcillin by pharmacodynamic antagonism. Minor/Significance Unknown.
- aztreonam
aztreonam, ticarcillin. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Combination may be used synergistically against Enterobacteriaceae.
- balsalazide
ticarcillin will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- biotin
ticarcillin will decrease the level or effect of biotin by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- chloramphenicol
chloramphenicol decreases effects of ticarcillin by pharmacodynamic antagonism. Minor/Significance Unknown.
- clarithromycin
clarithromycin decreases effects of ticarcillin by pharmacodynamic antagonism. Minor/Significance Unknown.
- colestipol
colestipol decreases levels of ticarcillin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
- erythromycin base
erythromycin base decreases effects of ticarcillin by pharmacodynamic antagonism. Minor/Significance Unknown.
- erythromycin ethylsuccinate
erythromycin ethylsuccinate decreases effects of ticarcillin by pharmacodynamic antagonism. Minor/Significance Unknown.
- erythromycin lactobionate
erythromycin lactobionate decreases effects of ticarcillin by pharmacodynamic antagonism. Minor/Significance Unknown.
- erythromycin stearate
erythromycin stearate decreases effects of ticarcillin by pharmacodynamic antagonism. Minor/Significance Unknown.
- gentamicin
ticarcillin decreases effects of gentamicin by altering metabolism. Minor/Significance Unknown. Increased risk in renal impairment.
- neomycin PO
ticarcillin decreases effects of neomycin PO by altering metabolism. Minor/Significance Unknown. Increased risk in renal impairment.
- pantothenic acid
ticarcillin will decrease the level or effect of pantothenic acid by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- paromomycin
ticarcillin decreases effects of paromomycin by altering metabolism. Minor/Significance Unknown. Increased risk in renal impairment.
- pyridoxine
ticarcillin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- pyridoxine (Antidote)
ticarcillin will decrease the level or effect of pyridoxine (Antidote) by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- roxithromycin
roxithromycin decreases effects of ticarcillin by pharmacodynamic antagonism. Minor/Significance Unknown.
- streptomycin
ticarcillin decreases effects of streptomycin by altering metabolism. Minor/Significance Unknown. Increased risk in renal impairment.
- thiamine
ticarcillin will decrease the level or effect of thiamine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- tobramycin
ticarcillin decreases effects of tobramycin by altering metabolism. Minor/Significance Unknown. Increased risk in renal impairment.
Adverse Effects
1-10%
Rash
Nausea
Diarrhea
Phlebitis at injection site
Increased eosinophils
Increased AST
Increased ALT
Postmarketing Reports
Hypersensitivity reactions: Skin rash, pruritus, urticaria, arthralgia, myalgia, drug fever, chills, chest discomfort, anaphylactic reactions, and bullous reactions (including erythema multiforme, toxic epidermal necrolysis, and Stevens-Johnson syndrome)
CNS: Headache, giddiness, neuromuscular hyperirritability, or convulsive seizures
Gastrointestinal: Disturbances of taste and smell, stomatitis, flatulence, nausea, vomiting and diarrhea, epigastric pain, and pseudomembranous colitis have been reported; onset of pseudomembranous colitis symptoms may occur during or after antibacterial treatment
Hemic and lymphatic systems: Thrombocytopenia, leukopenia, neutropenia, eosinophilia, reduction of hemoglobin or hematocrit, and prolongation of prothrombin time and bleeding time
Hepatic function tests: Elevation of AST, ALT, serum alkaline phosphatase, serum LDH, and serum bilirubin; transient hepatitis and cholestatic jaundice reported
Renal: Hemorrhagic cystitis, elevation of serum creatinine and/or BUN, hypernatremia, reduction in serum potassium, and uric acid
Local reactions: Pain, burning, swelling, and induration at the injection site, and thrombophlebitis with IV administration
Warnings
Contraindications
Allergy to penicillins or other beta-lactam antibacterials (eg, cephalosporins, imipenem)
Cautions
Serious and occasionally fatal hypersensitivity reactions reported
Clostridium difficile associated diarrhea reported with use of nearly all antibacterial agents, including ticarcillin
Seizures reported when dose exceeded, especially in presence of renal impairment
Risk of bleeding complication
Potential for microbial overgrowth or bacterial resistance
Laboratory tests: High urine concentrations of ticarcillin may produce false-positive protein reactions; clavulanate may cause a nonspecific binding of IgG and albumin by RBC leading to a false-positive Coombs test
Hypokalemia reported
Monitor renal, hepatic, and hematologic function
Pregnancy & Lactation
Pregnancy Category: B
Lactation: excreted into breast milk at low concentrations; use caution
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Inhibits cell wall biosynthesis by binding to 1 of more penicillin binding proteins, which subsequently inhibits bacterial cell wall synthesis and has a bactericidal effect
Absorption
Absorption: 86% (IM)
Peak Plasma Time: 30-75 min (IM)
Peak Plasma Concentration: 324 mcg/mL (immediately after 30 min IV infusion of 3.1 g)
AUC: 485 mcg•hr/mL (ticarcillin); 8.2 mcg•hr/mL (clavulanic acid)
Distribution
Protein Bound: 45 (ticarcillin); 25% (Clavulanate)
Distributed into bile, low concentrations in CSF
Metabolism
Liver
Elimination
Half-life: 1.1 hr adults; 4.4 hr neonates; 1 hr infants/children
Excretion: 60-70% urine (ticarcillin), 35-45% (clavulainic acid), excreted unchanged in first 6 hr after administration
Administration
IV Incompatibilities
Additive: sodium bicarbonate, aminoglycosides, ciprofloxacin(?)
Y-site: alatrofloxacin, amphotericin B cholesteryl sulfate, azithromycin, cisatracurium(?), topotecan(?), vancomycin(?)
IV Compatibilities
Solution: compatible w/ most common solvents
Y-site: (partial list) allopurinol, clarithromycin, diltiazem, fluconazole, heparin, meperidine, morphine, ondansetron, propofol
IV Preparation
Reconstitute 3.1 g vial with 13 mL SWI or NS; final concentration 200 mg/6.7 mg/mL
For intermittent IV infusion, further dilute to 10-100 mg/mL (ticarcillin component with compatible IV solution
Bulk vial 30 g/1 g
- Not for direct infusion
- Reconstitute with 76 mL SWI or NS; final concentration 300 mg/10 mg/mL
- Further dilute before administration to 10-100 mg/mL (ticarcillin component)
IV Administration
Intermittent IV infusion over 30 min
Administer 1 hr apart from aminoglycosides
Storage
Reconstituted solution is stable for 6 hr at room temperature and 72 hr when refrigerated
IV infusion in NS is stable for 24 hr at room temperature and 7 days when refrigerated, or 30 days when frozen
Darkening indicates loss of potency
Images
Formulary
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